(b) Past or predicted future condition if such
information is relevant to the determination of the employee’s eligibility for
compensation or accident benefits pursuant to chapters 616A to 616D, inclusive, of NRS.

2. The results of any medical treatment,
evaluation or test that was conducted to determine whether an injured employee
is eligible for compensation or accident benefits pursuant to chapters 616A to 616D, inclusive, of NRS.

(Added to NAC by Div. of Industrial Relations by R167-97,
eff. 1-30-98)

NAC 616D.0065“Compensated representative of an injured employee” defined. (NRS 616A.400)“Compensated
representative of an injured employee” means any person who receives payment
for assisting an injured employee to obtain compensation or accident benefits
pursuant to chapters 616A to 616D, inclusive, of NRS, regardless of
whether the person is paid by the injured employee or a third party.

(Added to NAC by Div. of Industrial Relations by R167-97,
eff. 1-30-98)

NAC 616D.007“Expected annual premium” defined. (NRS 616A.400)“Expected
annual premium” means an estimate of the total amount of money to be paid by an
employer to his or her insurer to provide, secure and maintain compensation as
required by the terms of chapters 616A
to 616D, inclusive, of NRS for a
fiscal or calendar year.

(Added to NAC by Div. of Industrial Relations by R168-97,
eff. 1-30-98)

NAC 616D.008“Log of oral communications” defined. (NRS 616A.400)“Log of
oral communications” means a record, in a written form or in a form from which
a written record may be produced, maintained by a person specified in
subsection 1 of NRS 616D.330
of any oral communication the person initiated with an injured employee’s
examining or treating physician or chiropractor, or an employee of the
examining or treating physician or chiropractor, relating to the medical
disposition of a claim of an injured employee.

(Added to NAC by Div. of Industrial Relations by R167-97,
eff. 1-30-98)

PROCEEDINGS BEFORE ADMINISTRATOR

NAC 616D.009“Administrator” defined. (NRS 616A.400)As used
in NAC 616D.009 to 616D.075,
inclusive, unless the context otherwise requires, “Administrator” means the
Administrator or a person designated by him or her to conduct a hearing.

(Added to NAC by Div. of Industrial Relations by R006-97,
eff. 12-9-97; A by R092-98, 12-18-98)

NAC 616D.010Procedure at hearings. (NRS 616A.400, 616D.050)At any
hearing, an insurer, employer or injured employee, or counsel for any of them
or the Administrator may:

1. Call and examine witnesses;

2. Introduce into evidence written exhibits
relevant to the issues to be decided;

3. Cross-examine opposing witnesses on any
matter relevant to the issues of the case; and

4. Submit written legal arguments.

(Added to NAC by Div. of Industrial Insurance
Regulation, eff. 2-22-88; A by Div. of Industrial Relations by R006-97, 12-9-97)

NAC 616D.012Scheduling of prehearing conference. (NRS 616A.400, 616D.050)The
Administrator may schedule a prehearing conference in any case to discuss
settlement, discovery, scheduling or other matters pertinent to the case and
may enter any order relating to those matters.

(Added to NAC by Div. of Industrial Relations by R092-98,
eff. 12-18-98)

(Added to NAC by Div. of Industrial Relations by R092-98,
eff. 12-18-98)

NAC 616D.016Failure to comply with regulations. (NRS 616A.400, 616D.050)If a
party or his or her counsel fails or refuses to comply with NAC 616D.009 to 616D.075,
inclusive, the Administrator may make such orders as are necessary to direct
the course of the hearing, including, without limitation:

1. Continuing the hearing until the party or
his or her counsel complies with the requirements.

2. Restricting or prohibiting the
introduction of evidence.

3. Dismissing the matter.

(Added to NAC by Div. of Industrial Relations by R092-98,
eff. 12-18-98)

1. An insurer or employer may be represented
in any proceeding before the Administrator by a corporate officer, employee or
other authorized representative.

2. Any attorney appearing on behalf of a
party in a proceeding before the Administrator must be licensed to practice law
before all the courts of this State.

3. The counsel of record shall be deemed to
be counsel for the party in all proceedings before the Administrator until
written notice of the withdrawal and substitution of counsel is filed with the
Administrator.

4. Counsel for an injured employee who filed
a complaint with the Division pursuant to NRS 616D.130 shall be deemed to
be the counsel of record for the injured employee in all proceedings before the
Administrator arising from the complaint, until written notice of the
withdrawal and substitution of counsel is filed with the Administrator.

(Added to NAC by Div. of Industrial Insurance
Regulation, eff. 2-22-88; A by Div. of Industrial Relations by R006-97, 12-9-97;
R092-98, 12-18-98)

NAC 616D.022Request for interpreter. (NRS 616A.400, 616D.050)A party
who requires assistance in interpreting the English language during a
proceeding before the Administrator must notify the Administrator in writing at
least 10 days before the hearing at which such assistance is required. The
Administrator will appoint an interpreter and arrange for the interpreter to attend
the hearing at no cost to the party who requires such assistance.

(Added to NAC by Div. of Industrial Relations by R092-98,
eff. 12-18-98)

NAC 616D.030Continuances. (NRS 616A.400, 616D.050)A
hearing before the Administrator may be continued by the Administrator upon:

1. His or her own motion for good cause;

2. The written stipulation of the parties to
the proceeding if written approval is given by the Administrator and the
continuance is obtained not less than 5 days before the scheduled hearing; or

3. An affidavit showing good cause filed by
a party to the proceeding not less than 5 days before the scheduled hearing.

(Added to NAC by Div. of Industrial Insurance
Regulation, eff. 2-22-88; A by Div. of Industrial Relations by R006-97, 12-9-97)

NAC 616D.040Materials to be filed before hearing; time for filing; filing by
Administrator of statement of position. (NRS 616A.400, 616D.050)

1. Within the times prescribed in subsection
2, each party shall file with the Administrator and serve upon all other
parties:

(a) All documents to be introduced as evidence at
the hearing;

(b) A statement of the issues to be raised;

(c) A list of witnesses, a brief summary of
proposed testimony and a statement indicating whether any of the testimony is
to be taken by use of the telephone; and

(d) An estimate of the length of time required to
present the case, including rebuttal testimony and argument.

2. The materials required by subsection 1
must be filed:

(a) By the appellant, at least 14 days before the
scheduled hearing.

(b) By a respondent, at least 7 days before the
scheduled hearing.

3. The Administrator may upon his or her own
motion file a statement of position.

(Added to NAC by Div. of Industrial Insurance
Regulation, eff. 2-22-88; A by Div. of Industrial Relations by R006-97, 12-9-97)

1. A party who wishes the Administrator to
issue a subpoena requiring the attendance of a witness or the production of a
book, account, paper, record or other document must submit a request for a
subpoena to the Administrator:

(a) At any prehearing conference held in the
matter;

(b) At least 10 days before the hearing; or

(c) As otherwise allowed by the Administrator.

2. A request for a subpoena must:

(a) Set forth the reason why the subpoena is
necessary; and

(b) Be accompanied by a completed form for the
subpoena.

3. The Administrator will:

(a) Approve the request for a subpoena if the
Administrator determines that the witness or document requested is relevant to
the issues in the matter and the party requesting the subpoena is otherwise
unable to compel the attendance of the witness or the production of the
document.

(b) Approve or deny the request for a subpoena
within 5 days after the receipt of the request.

4. A subpoena for the production of a book,
account, paper, record or other document must include, without limitation, a
notice that indicates the manner in which the requested document may be
provided without requiring the appearance of a person at the hearing.

(Added to NAC by Div. of Industrial Relations by R092-98,
eff. 12-18-98)

1. A party who wishes to transfer a hearing
to or from Carson City or Las Vegas must submit a written motion for a change
of venue to the Administrator at least 10 days before the scheduled hearing.
The motion must be accompanied by an affidavit from the moving party which sets
forth whether or not any other party to the proceeding opposes the motion. The
moving party must serve a copy of the motion on all other parties to the
proceeding.

2. A motion for a change of venue must be
administered pursuant to NAC 616D.046.

(Added to NAC by Div. of Industrial Relations by R092-98,
eff. 12-18-98)

1. Testimony may be taken by the
Administrator by use of the telephone. If a party requests that testimony be
taken by the Administrator by use of the telephone, the party must provide,
before the hearing, written notification of the request to all of the other
parties to the proceeding and the Administrator. The Administrator will
determine any issues relating to the credibility of such testimony in the same
manner as he or she determines the credibility of any other testimony.

2. The party requesting the taking of
testimony by use of the telephone is responsible for the charges for the call,
unless the person providing testimony by telephone pays the costs of the
telephone call or otherwise accepts the charges for the call when he or she
presents his or her testimony at the hearing.

3. If a party requests to present testimony
by telephone and is not available to do so when the Administrator places the
call, the party shall be deemed to have failed to appear.

(Added to NAC by Div. of Industrial Relations by R092-98,
eff. 12-18-98)

1. A party who wishes to introduce evidence
that is recorded on videotape must submit to the Administrator a written
request therefor and a summary of the evidence so recorded in the statement of
the issues to be raised at the hearing at least 14 days before the hearing or
as otherwise allowed by the Administrator.

2. The Administrator will grant or deny the
request within 5 days after the receipt of the request.

3. The party requesting the introduction of
such evidence shall:

(a) At least 14 days before any hearing, or as
otherwise allowed by the Administrator, provide an unedited copy of the
evidence to the opposing party free of charge; and

(b) Provide all equipment necessary to display the
videotape at the hearing.

(Added to NAC by Div. of Industrial Relations by R092-98,
eff. 12-18-98)

1. Papers and documents filed pursuant to NAC 616D.009 to 616D.075,
inclusive, need not conform to any particular format.

2. All papers and documents, and copies
thereof, must be legible.

3. A party shall furnish to the counsel for
any other party to the proceeding, or directly to the other party if he or she
is not represented by counsel, copies of all papers and documents served upon
any party or filed with the Administrator.

4. Papers and documents offered as evidence,
except for good cause shown, must not be marked with highlighting, underlining,
annotations or any other device that serves to draw attention to one part of
the document over another part or one document over another document or to
comment on the contents of the document.

5. The Administrator may seal the record or
require any party to the proceeding to redact confidential information from
submitted papers and documents, including, without limitation, the name,
address and social security number of the injured employee.

(Added to NAC by Div. of Industrial Relations by R092-98,
eff. 12-18-98)

NAC 616D.060Findings of fact and conclusions of law; notice of right to file
petition for judicial review. (NRS 616A.400, 616D.050) If,
after a hearing, the Administrator decides that the insurer, third-party
administrator, organization for managed care, provider of health care or
employer has committed the alleged violation, the Administrator will:

1. Prepare written findings of fact and
conclusions of law;

2. Give notice of the right to file a
petition for judicial review within 30 days after service of the decision; and

3. Cause a copy of the findings of fact and
conclusions of law to be served upon the insurer, third-party administrator,
organization for managed care, provider of health care or employer by certified
mail.

(Added to NAC by Div. of Industrial Insurance
Regulation, eff. 2-22-88; A by Div. of Industrial Relations by R006-97, 12-9-97)

NAC 616D.065Failure to appear. (NRS 616A.400, 616D.050)If a
party who appeals fails to appear after due notice has been given and good
cause is not shown for the failure to appear, the Administrator may:

1. Dismiss the case, with or without
prejudice; or

2. Take testimony and evidence from the
parties appearing and rule on the matter.

(Added to NAC by Div. of Industrial Relations by R092-98,
eff. 12-18-98)

1. A written petition for a reconsideration
or rehearing based on good cause or newly discovered evidence may be filed with
the Administrator within 15 days after the service of a notice of the final
decision. A copy of the petition must be served upon the other parties to the
proceeding within the same time.

2. The Administrator may grant or deny the
petition for reconsideration or rehearing within 5 days after the receipt of
the petition. If the petition is:

(a) Granted, the rehearing or reconsideration must
be held within 30 days after the petition is granted.

(b) Denied, the time limit in which to file a
petition for judicial review with the appropriate district court is not
extended by the filing of a petition for reconsideration or rehearing.

3. Only one petition for reconsideration or
rehearing will be considered for each party in a specific case.

(Added to NAC by Div. of Industrial Relations by R092-98,
eff. 12-18-98)

1. A decision of a court, a hearing officer,
an appeals officer or the Division shall be deemed to be:

(a) Any written order or decision entered by a
court of competent jurisdiction, hearing officer or appeals officer, including,
without limitation, a written determination that is not appealed in a timely
manner;

(b) Any written decision issued by the Division;
and

(c) A written settlement agreement or written
stipulation that is modified or changed by a court of competent jurisdiction, a
hearing officer, an appeals officer or the Division.

2. “Payment of compensation” means:

(a) The payment of accident, medical or other
benefits to an injured employee or his or her dependents;

(b) The payment of accident, medical or other
benefits to persons other than an injured employee or his or her dependents;

(c) Giving written notice to an injured employee of
the date, time and place of an appointment for the receipt of accident, medical
or other benefits; and

(d) Providing an evaluation of or treatment to an injured
employee for an industrial injury or occupational disease for which accident,
medical or other benefits are payable.

3. “Written settlement agreement” means any
agreement that is in writing or in the form of minutes or a transcript.

4. “Written stipulation” means any
stipulation that is in writing or in the form of minutes or a transcript.

(Added to NAC by Div. of Industrial Relations by R010-97,
eff. 11-5-97; A by R105-00, 1-18-2001, eff. 3-1-2001)

1. Each insurer, organization for managed
care, health care provider or third-party administrator shall establish written
policies and procedures for the payment of compensation found to be due by a
hearing officer, appeals officer, court of competent jurisdiction, written
settlement agreement, written stipulation or the Division when carrying out its
duties pursuant to chapters 616A to 616D, inclusive, or chapter 617 of NRS.

2. The policies and procedures adopted
pursuant to subsection 1 must:

(a) Provide that payment be made within the time
set forth in paragraph (c) of subsection 1 of NRS 616D.120;

(b) Provide for the quick and efficient payment of
compensation to injured employees and their dependents in a manner that is
consistent with the provisions of chapters
616A to 617, inclusive, of NRS;

(c) Establish a procedure for the clarification of
any ambiguity in the payment of compensation found to be due an injured
employee by a hearing officer, appeals officer, court of competent
jurisdiction, written settlement agreement, written stipulation or the Division
within the time set forth in paragraph (c) of subsection 1 of NRS 616D.120;

(d) Provide for the designation of a person or
persons to receive and calendar notices for the payment of compensation found
to be due an injured employee by a hearing officer, appeals officer, court of
competent jurisdiction, written settlement agreement, written stipulation or
the Division; and

(e) Provide for the designation of a person or
persons to pay any compensation found to be due an injured employee by a
hearing officer, appeals officer, court of competent jurisdiction, written
settlement agreement, written stipulation or the Division within the time set
forth in paragraph (c) of subsection 1 of NRS 616D.120.

(Added to NAC by Div. of Industrial Relations by R010-97,
eff. 11-5-97)

NAC 616D.315Considerations for determining unreasonable delay in payment. (NRS 616A.400, 616D.120)For the
purposes of paragraph (c) of subsection 1 of NRS 616D.120, to determine
whether an insurer, organization for managed care, health care provider,
third-party administrator, employer or employee leasing company has
unreasonably delayed payment to an injured employee of compensation found to be
due him or her by a hearing officer, appeals officer, court of competent
jurisdiction, written settlement agreement, written stipulation or the Division
when carrying out its duties pursuant to chapters
616A to 617, inclusive, of NRS,
the Administrator will consider:

1. The reasons given by the insurer,
organization for managed care, health care provider, third-party administrator,
employer or employee leasing company for making the payment after the time set
forth in paragraph (c) of subsection 1 of NRS 616D.120;

2. The efforts made by the insurer,
organization for managed care, health care provider, third-party administrator,
employer or employee leasing company to make the payment within the time set
forth in paragraph (c) of subsection 1 of NRS 616D.120, if any;

3. The date the payment was made;

4. Whether the amount of compensation due,
or any portion of that amount, was unclear or ambiguous and whether the
insurer, organization for managed care, health care provider, third-party
administrator, employer or employee leasing company took action or exercised
reasonable diligence to clarify the uncertainty or ambiguity and to pay the
compensation due within the time set forth in paragraph (c) of subsection 1 of NRS 616D.120, or at any time
thereafter;

5. Whether the amount of compensation due,
or any portion of that amount, was unknown or could have been determined
through the exercise of reasonable diligence within the time set forth in
paragraph (c) of subsection 1 of NRS
616D.120, or at any time thereafter;

6. Whether the insurer, organization for
managed care, health care provider, third-party administrator, employer or
employee leasing company was advised, in writing, by the injured employee or a
representative thereof that payment of the compensation due could be delayed
pending the outcome of any further negotiations relating to the compensation
that was due;

7. Whether the insurer, organization for
managed care, health care provider or third-party administrator established the
policies and procedures required by NAC 616D.311
and complied with those policies and procedures;

8. Whether the delay in the payment of the
compensation due, or any portion thereof, was the result of error, lack of good
faith or diligence, neglect or another cause within the control of the insurer,
organization for managed care, health care provider, third-party administrator,
employer or employee leasing company; and

9. Any other circumstance which the
Administrator deems relevant to determine whether a delay in the payment of
compensation due was reasonable.

(Added to NAC by Div. of Industrial Relations by R010-97,
eff. 11-5-97; A by R149-09, 10-23-2013)

Employers

NAC 616D.333Order for cessation of business: Service. (NRS 616A.400, 616D.110)An order
for the cessation of business will be delivered to and served upon the
employer, manager or supervisor at the place of employment or jobsite, or upon
an employee of suitable age and discretion if the employer, manager and
supervisor are absent, by a representative of the Administrator or by a peace
officer who is authorized to serve judicial process and is designated by the
Administrator to serve the order.

1. The representative of the Administrator
who delivers the order of cessation of business shall remain at the place of
employment or jobsite to witness that the employer immediately orders all
employees and other persons present to leave the place of employment or jobsite
and that all operations are terminated.

2. If the representative of the
Administrator observes that the terms of the order are not carried out
immediately, the representative must contact the nearest law enforcement agency
by the most expeditious means and request that the agency render assistance in
enforcing the terms of the order.

NAC 616D.340Failure to provide and secure compensation or to report material
fact concerning amount of payroll: Provision of certain information to or
estimation of premiums by Administrator. (NRS 616A.400, 616D.200, 616D.220)

1. If the Administrator notifies an employer
that the employer failed to provide and secure compensation as required by the
terms of chapters 616A to 616D, inclusive, of NRS and that the
employer is required to provide information to the Administrator for the
calculation of the premiums that would otherwise have been owed to a private
carrier, the employer or the former or current private carrier of the employer,
as applicable, must provide written information to the Administrator that
verifies the amount of the premiums that the employer otherwise would have owed
to a private carrier for the period that the employer was uninsured.

2. If the Administrator notifies an employer
that the employer knowingly failed to report a material fact concerning the
amount of payroll upon which his or her premium was based pursuant to NRS 616C.220 and that the
employer is required to provide information to the Administrator for the
calculation of the premium that would have been due had the proper information
been submitted, the employer or the former or current private carrier of the
employer, as applicable, must provide written information to the Administrator
that verifies the amount of the premium that would have been due if the proper
information had been submitted.

3. If the employer or the former or current
private carrier of the employer, as applicable, fails or is unable to provide
the information required pursuant to subsection 1 or 2, the employer shall
verify the actual amount of the pay earned by his or her employees during the
period that the employer was uninsured or in which the employer knowingly
failed to report a material fact concerning the amount of payroll upon which
the premium was based.

4. If the employer or the former or current
private carrier of the employer, as applicable, fails or is unable to provide
the information required by subsection 1, 2 or 3, the Administrator may
estimate the premiums that the employer otherwise would have owed to a private
carrier for the period during which the employer was uninsured or during which
the employer failed to report a material fact concerning the amount of payroll
upon which the premium was based.

(Added to NAC by Industrial Insurance System, eff. 5-23-96;
A by Div. of Industrial Relations by R166-97, 1-30-98; R007-06, 6-1-2006)

1. If the Fraud Control Unit for Industrial
Insurance established pursuant to NRS
228.420 does not prosecute an employer for failing to provide and secure
compensation as required by the terms of chapters
616A to 616D, inclusive, of NRS
or any regulation adopted pursuant thereto, the Administrator will:

(a) For a failure to provide and secure
compensation for a period of 90 days or less, impose an administrative fine not
to exceed $1,000.

(b) For a failure to provide and secure
compensation for a period of more than 90 days, but not more than 1 year,
impose an administrative fine in an amount not to exceed $5,000.

(c) For a failure to provide and secure compensation
for a period of more than 1 year, impose an administrative fine not to exceed
$15,000.

2. In determining the amount of the
administrative fines pursuant to subsection 1, the Administrator will consider
whether:

(a) The employer is a small employer; and

(b) The failure to provide and secure compensation
was the result of:

(1) An error of a private carrier or other
third party;

(2) An unintentional error of the employer; or

(3) An intentional violation by the employer.

3. If the employer is a small employer and
the failure to provide and secure compensation was not the result of an
intentional violation by the employer, the Administrator may reduce the
administrative fine imposed pursuant to this section by not more than 50
percent of the fine.

4. As used in this section, “small employer”
means an employer which employs less than 150 full-time or part-time employees.

(Added to NAC by Div. of Industrial Relations by R168-97,
eff. 1-30-98; A by R105-00, 1-18-2001, eff. 3-1-2001; R007-06, 6-1-2006)

1. For the purposes of subsection 2 of NRS 616D.120 and except as
otherwise provided in chapters 616A
to 617, inclusive, of NRS, or in any
regulation adopted pursuant thereto, an insurer, organization for managed care,
health care provider, third-party administrator, employer or employee leasing
company commits a “minor violation” of any provision of chapter 616A, 616B, 616C, 616D or 617 of NRS, or a regulation adopted
pursuant thereto, if the violation is a single, unintentional violation and the
insurer, organization for managed care, health care provider, third-party
administrator, employer or employee leasing company agrees, in writing, to
correct the violation during the course of an investigation or audit conducted
pursuant to those chapters.

2. Except as otherwise provided in this
subsection, if an insurer, organization for managed care, health care provider,
third-party administrator, employer or employee leasing company agrees, in
writing, to correct a single, unintentional violation during the course of an
investigation or audit, the Administrator will issue a notice of correction for
that violation. The Administrator will not issue a notice of correction
pursuant to this subsection if the violation does not require correction or the
correction is unnecessary or moot.

3. If an insurer, organization for managed
care, health care provider, third-party administrator, employer or employee
leasing company does not agree, in writing, to correct a single, unintentional
violation during the course of an investigation or audit, the Administrator may
impose an administrative fine in an amount not to exceed those amounts set
forth in subsection 2 of NRS
616D.120 or order a plan of corrective action to be submitted to the
Administrator, or both.

1. For the purposes of NRS 616D.120, an insurer,
organization for managed care, health care provider, third-party administrator,
employer or employee leasing company commits an “intentional violation” of any
provision of chapter 616A, 616B, 616C, 616D or 617 of NRS, or any regulation adopted
pursuant thereto, if he or she acts with purpose or design, otherwise acts to
cause the consequences, desires to cause the consequences or believes that the
consequences are substantially certain to result from the violation.

2. The Administrator may consider two or
more violations of the same or similar provisions of chapters 616A to 617, inclusive, of NRS, or any
regulations adopted pursuant thereto, as evidence of an intentional violation.
If the Administrator determines that two or more violations constitute an
intentional violation, the Administrator will impose an administrative fine as
required by subsection 1 of NRS
616D.120 and, if appropriate, order a plan of corrective action to be
submitted to the Administrator.

(Added to NAC by Div. of Industrial Relations by R118-02,
eff. 9-7-2005; A by R149-09, 10-23-2013)

1. To determine the amount of a benefit
penalty required to be paid pursuant to subsection 3 of NRS 616D.120, the Administrator
will determine that the violation caused physical or economic harm to the
injured employee or his or her dependents if the Administrator finds, by a
preponderance of the evidence, that:

(a) The harm would not have occurred but for the
violation;

(b) The violation was a substantial factor in
bringing about the harm; and

(c) There is no supervening cause that is
responsible for bringing about the harm.

2. Physical harm must be established by a
preponderance of objective medical evidence in the form of existing medical
records or medical records furnished by the claimant.

3. The Administrator will determine the
amount of a benefit penalty required to be paid pursuant to subsection 3 of NRS 616D.120 according to the
following schedule. In addition to the required minimum benefit penalty of
$5,000, a claimant will be awarded $2,250 for each point assessed, but in no
event will the amount of the benefit penalty be greater than $50,000.

More than $15,000.................................................................................................... 10
points

4. To determine the number of prior
violations of an insurer, organization for managed care, health care provider,
third-party administrator, employer or employee leasing company, the
Administrator will:

(a) Consider only those fines and benefit penalties
imposed pursuant to paragraphs (a) to (e), inclusive, (h) and (i) of subsection
1 of NRS 616D.120 using the 3
most recent complete years of available data.

5. To determine the average number of claims
handled in the past 3 years, the Administrator will consider the 3 most recent
complete years of available data.

6. As used in this section:

(a) “Dependent” means a person who:

(1) At the time of the violation, is:

(I) The spouse of the injured employee;

(II) A child of the injured employee and
is under 18 years of age; or

(III) A child of the injured employee, is
18 years of age or older and is physically or mentally incapacitated and unable
to earn a wage; or

(2) Is a parent of the injured employee, a
child of the injured employee who is 18 years of age or older, a stepchild of
the injured employee or a sibling of the injured employee if that person’s
dependency upon the injured employee is established by a federal income tax
return of the injured employee or by any other reliable evidence.

(b) “Economic harm” includes:

(1) The loss of money or an item of monetary
value; and

(2) The deprivation of a reasonable
expectation of a financial or monetary advantage.

(c) “Number of claims handled” means the total
number of claims accepted, denied or reopened during a 1-year period.

(d) “Permanent major harm” means physical harm
that:

(1) Results in a complete or significant loss
of the ability to engage in activities of daily living, including, without
limitation, caring for oneself, performing manual tasks, walking, standing,
sitting, seeing, hearing, speaking, breathing, learning, working, sleeping,
functioning sexually, and engaging in normal recreational and social
activities; and

(2) Is unlikely to be alleviated in spite of
medical treatment that a reasonable person is willing to undergo.

(e) “Permanent minor harm” means physical harm
that:

(1) Does not result in a complete or
significant loss of the ability to engage in activities of daily living,
including, without limitation, caring for oneself, performing manual tasks,
walking, standing, sitting, seeing, hearing, speaking, breathing, learning,
working, sleeping, functioning sexually, and engaging in normal recreational
and social activities; and

(2) Is unlikely to be alleviated in spite of
medical treatment that a reasonable person is willing to undergo.

(f) “Physical harm” means death or any
physiological disorder or condition, cosmetic disfigurement or anatomic loss
affecting one or more of the following body systems:

(1) Results in a complete or significant loss
of the ability to engage in activities of daily living, including, without
limitation, caring for oneself, performing manual tasks, walking, standing,
sitting, seeing, hearing, speaking, breathing, learning, working, sleeping,
functioning sexually, and engaging in normal recreational and social
activities; and

(2) Is likely to be alleviated with or without
medical treatment.

(h) “Temporary minor harm” means physical harm
that:

(1) Does not result in a complete or
significant loss of the ability to engage in activities of daily living,
including, without limitation, caring for oneself, performing manual tasks,
walking, standing, sitting, seeing, hearing, speaking, breathing, learning,
working, sleeping, functioning sexually, and engaging in normal recreational
and social activities; and

(2) Is likely to be alleviated with or without
medical treatment.

(Added to NAC by Div. of Industrial Relations by R118-02,
eff. 9-7-2005; A by R007-06, 6-1-2006; R149-09, 10-23-2013)

1. For the purposes of paragraph (h) of
subsection 1 of NRS 616D.120,
to determine whether an insurer, organization for managed care, health care
provider, third-party administrator, employer or employee leasing company has
engaged in a pattern of untimely payments to injured workers, the Administrator
will consider:

(a) The reasons given by the insurer, organization
for managed care, health care provider, third-party administrator, employer or
employee leasing company for making the payments after the time set forth in
the applicable statute or regulation;

(b) The efforts made by the insurer, organization
for managed care, health care provider, third-party administrator, employer or
employee leasing company to make the payments within the time set forth in the
applicable statute or regulation;

(c) The date the payments were made;

(d) The number of injured employees who have
received untimely payments;

(e) The number of untimely payments;

(f) The length of the time period in which the
untimely payments occurred;

(g) Whether the amount of any payments due, or any
portion of that amount, was unknown, unclear or ambiguous, and whether the
insurer, organization for managed care, health care provider, third-party
administrator, employer or employee leasing company took action or exercised
reasonable diligence to determine the unknown amounts or to clarify the
uncertainty or ambiguity and to make the payments due within the time set forth
in the applicable statute or regulation or at any time thereafter;

(h) Whether the insurer, organization for managed
care, health care provider, third-party administrator, employer or employee
leasing company was advised, in writing, by the affected injured employee or a
representative thereof that payments could be delayed pending the outcome of
any further negotiations relating to the compensation that was due;

(i) Whether successive or numerous untimely
payments have been made to a single injured employee;

(j) Whether the untimely payments involved the same
form of compensation, such as temporary total disability;

(k) Whether the insurer, organization for managed
care, health care provider, third-party administrator, employer or employee
leasing company knew or reasonably should have known of the circumstances
resulting in or likely to result in multiple untimely payments to one or more
injured employees;

(l) Whether the insurer, organization for managed
care, health care provider or third-party administrator established the
policies and procedures required by NAC 616D.311
and complied with those policies and procedures;

(m) Whether the untimely payments were the result
of error, lack of good faith or diligence, neglect or another cause within the
control of the insurer, organization for managed care, health care provider,
third-party administrator, employer or employee leasing company; and

(n) Any other circumstance which the Administrator
deems relevant to determine whether untimely payments to one or more injured
employees constitute a pattern of untimely payments that warrants awarding a
benefit penalty to an injured employee.

2. Timeliness of payments must be determined
by the statute or regulation specifically applicable to the type of payment
involved.

3. The insurer or third-party administrator
shall record in the claim file the date on which any payment of compensation or
other relief pursuant to chapters 616A
to 617, inclusive, of NRS is made to
an injured employee or other person or has been deposited for mailing to the
injured employee or other person. This information must be provided to the
Administrator upon request.

(Added to NAC by Div. of Industrial Relations by R149-09,
eff. 10-23-2013)

NAC 616D.415Imposition of administrative fine or order for corrective action
for certain unintentional or multiple violations. (NRS 616A.400, 616D.120)Except
as otherwise provided in chapters 616A
to 617, inclusive, of NRS, or in any
regulation adopted pursuant thereto:

1. If the Administrator determines that:

(a) An insurer or third-party administrator has
failed to comply or has complied in an untimely manner with any provision of chapter 616A, 616B, 616C, 616D or 617 of NRS, or any regulation adopted
pursuant thereto, that requires the insurer or third-party administrator to
make a determination regarding the acceptance or denial of a claim for
compensation;

(b) An insurer or third-party administrator has
failed to comply or has complied in an untimely manner with any provision of chapter 616A, 616B, 616C, 616D or 617 of NRS, or any regulation adopted
pursuant thereto, that requires the insurer or third-party administrator to
make a payment of benefits to an injured employee;

(d) An insurer, organization for managed care,
provider of health care, third-party administrator, employer or employee
leasing company has failed to comply or has complied in an untimely manner with
any of the provisions of NRS
616A.475, 616B.006, 616B.009 or 617.357 or NAC 616A.410;

(e) A treating physician or chiropractor has failed
to comply or has complied in an untimely manner with any of the provisions of NRS 616C.020, 616C.040, subsection 7 of NRS 616C.475 or NRS 617.352, or any regulations
adopted pursuant thereto, that require the treating physician or chiropractor
to complete a claim for compensation; or

(f) An employer has failed to comply or has
complied in an untimely manner with any of the provisions of NRS 616C.045 or 617.354, or any regulation adopted
pursuant thereto, that require the employer to complete a report of industrial
injury or occupational disease,

Ê and the
Administrator determines that the violation was not an intentional violation,
the Administrator may impose an administrative fine in an amount not to exceed
those amounts set forth in subsection 2 of NRS 616D.120 or order a plan of
corrective action to be submitted to the Administrator, or both.

2. If the Administrator determines that an
insurer, organization for managed care, health care provider, third-party
administrator, employer or employee leasing company has committed two or more
violations of the same or similar provisions of chapters 616A to 617, inclusive, of NRS, or any regulation
adopted pursuant thereto, the Administrator may impose an administrative fine
in an amount not to exceed those amounts set forth in subsection 2 of NRS 616D.120 or order a plan of
corrective action to be submitted to the Administrator, or both.

(Added to NAC by Div. of Industrial Relations by R118-02,
eff. 9-7-2005; A by R149-09, 10-23-2013)

1. An insurer, employer, organization for
managed care, a third-party administrator or the representative of any of those
persons, the Nevada Attorney for Injured Workers or an attorney or other
compensated representative of an injured employee who initiates an oral
communication relating to the medical disposition of a claim shall maintain a
log of oral communications for each claim of each injured employee with whom he
or she has had such communications.

2. The initiator may maintain a log of oral
communications in any file that he or she maintains concerning the injured
employee if the log of oral communications is maintained so that it is readily
available for production pursuant to the provisions of NAC
616D.455.

3. A log of oral communications must contain
the names of all parties included in each communication and the date, time and
subject matter of the communication.

(Added to NAC by Div. of Industrial Relations by R167-97,
eff. 1-30-98)

NAC 616D.455Log of oral communications: Availability. (NRS 616A.400, 616D.330)If a
person specified in subparagraph (2) of paragraph (a) of subsection 1 of NRS 616D.330 makes a written
request for a log of oral communications and, if requested, proves his or her
status as a person specified in subparagraph (2) of paragraph (a) of subsection
1 of NRS 616D.330, the person
who is required to maintain the log pursuant to subsection 1 of NRS 616D.330 shall make the log
available within 30 days after receipt of the written request.

(Added to NAC by Div. of Industrial Relations by R167-97,
eff. 1-30-98)